Provider Demographics
NPI:1932192507
Name:WILLIAMS, KIMIYO HARRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMIYO
Middle Name:HARRIS
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:200 HENRY CLAY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5720
Mailing Address - Country:US
Mailing Address - Phone:504-896-2723
Mailing Address - Fax:504-896-2720
Practice Address - Street 1:216 MYSTIC BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2870
Practice Address - Country:US
Practice Address - Phone:985-868-9339
Practice Address - Fax:985-868-9449
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0241512080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1489719Medicaid